OPINION: Red tape threatens access to mental health services for the most vulnerable
Like many psychologists and mental health professionals, my ability to provide patients with quality mental health care has been increasingly undermined by insurance companies demanding that I hurdle a mountain of red tape just to file a reimbursement claim. If insurers continue to hold down reimbursement rates, while demanding burdensome and time-consuming paperwork, more providers will refuse insurance payments and fewer low-income patients will have access to life-saving mental health treatment.
Insurance company red tape creates time-management issues, especially for mental health providers trying to see patients and simultaneously learn diagnostic codes and navigate inconsistent reimbursement forms. Even determining where and how to submit a claim can be challenging. Send the claim to the wrong department, the company rejects it. Submit a paper claim to a company that only accepts electronic claims, the company ignores it. Submit a claim to an insurance company that has outsourced its behavioral health services, the company returns it.
Even after mental health providers have compiled the correct information and submitted it in the proper way, we are rewarded with reimbursement rates that have been falling relative to inflation for nearly two decades. Most insurance companies tie their reimbursement rates to the rate Medicare reimburses for mental health services, which have not been raised in 18 years. Medicare today pays about 30 percent less per psychotherapy session than it did in 2001, after accounting for inflation. Since reimbursement rates from private insurers are based on the Medicare rate, they are kept lower than they would otherwise be and lower than the rates for other health care services.
Ballooning bureaucracies and shrinking reimbursement rates mean fewer mental health providers will take insurance. In 2010, as much as 55 percent of psychologist and psychiatrists did not accept private insurance and less than a third took Medicaid, according to the National Ambulatory Medical Care Survey. Sadly, after spending years making myself available to all those who might be in need, I have fallen into this category
The more providers shift to cash-only care, the less quality mental health treatment will be available for uninsured and low-income Americans. Unfortunately, these are often the communities with the greatest need for mental health and substance abuse services — treatments that can quite literally save lives.
In my practice, I work with young adults who have who typically have substance abuse issues co-occurring with a history of suicide attempts, suicidal ideation and self-harming behaviors. Luckily the families of many of my patients have agreed to pay out-of-pocket for a treatment that has, quite literally, kept them from killing themselves. But, they are the privileged ones. There are countless others who do not have access to the specialized training needed to treat their complex conditions.
Furthermore, low reimbursement rates and insurance company red tape also means fewer people want to become highly trained mental health care providers. The latest projections by the National Center for Health Workforce Analysis indicate that the nation may soon face a shortage of mental health providers. When demand for mental health services is high and supply of certified professionals is low, you can bet that only people rich enough to cover psychological services out of their own pocket will have access to quality mental health care.
Facing an opioid epidemic, skyrocketing rates of depression, and a climbing rate of suicide in young adults, the U.S. cannot afford to lose the highly trained mental health professionals that are many people’s only access to vital psychological and psychiatric care. If we intend to overhaul the nation’s health care system, we will need to address how insurance companies are restricting access to quality care by overworking providers with burdensome policies and procedures and underpaying them with deflated reimbursement rates.
Dr. Justin Jones is a clinical psychologist, licensed in both the states of New York and Massachusetts, who is trained in psychoanalytic, cognitive behavioral, dialectical behavioral, and humanistic/spiritual treatment modalities. He has graduate degrees from Columbia and Yale Universities.
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